More Is Not Always the Answer
A personal lesson from Dr. Ethan Lazarus about medication, restorative sleep, and why a comprehensive weight loss plan sometimes starts with reassessing what we add.
For the past 20 years, I’ve been getting up at night to pee.
There’s no particularly elegant way to say it. And if you deal with this too, you know how disruptive it can be. Over the years, it became four, five, sometimes six trips a night. Often, I couldn’t fall back asleep afterward.
I’m a doctor, but I’m also a patient. I’ve seen primary care doctors and specialists. I’ve tried this medication, that medication, more testing, different doses. Too often, the side effects felt worse than the benefits.
Eventually, I mostly learned to live with it.
Recently, though, I asked a different question.
Like many of you, I’ve been using AI more often. Sometimes it helps me think through a problem from another angle. This time, I asked: Could the medication I’m taking to make this better actually be making it worse?
The conversation raised a possibility I hadn’t considered: perhaps the medication was affecting my sleep.
That led to a second question:
Am I waking up because I need to pee—or am I peeing because I’m already awake?
After two decades of looking for answers, that question stopped me.
I’ve now been off the medication for about a month. The last four nights have been some of the best sleep I’ve had in decades.
Four nights don’t prove that the medication caused the problem. And an AI response isn’t proof of a medication side effect. But the improvement has been striking enough to make me reconsider something I’d assumed was helping.
It’s also reminded me of a lesson that matters in my weight loss practice: more is not always the answer.
When weight loss slows down, it’s understandable to wonder whether we should increase the dose or add another medication. Sometimes that is the right next step. Weight loss medications can be tremendously helpful.
But before we add more, we need to ask how the current treatment is working for the person taking it.
Are you feeling well? Can you eat enough to meet your nutritional needs? Do side effects interfere with your day? Are you sleeping? Do you have the energy to be active?
The number on the scale matters. So does how you feel getting there.
Medication is one of our tools, and it works within a larger plan. Food, activity, sleep, and stress all deserve attention throughout treatment. Healthy weight management includes each of these pieces, as the CDC explains.
I’ve written before about the three S’s of weight loss success—sleep, stress, and schedule. My own experience has given me a very personal reminder of why they matter.
Think about trying to follow your food plan after a night of broken sleep. Or finding the energy to exercise when you’re exhausted before the day begins. Those are real barriers, and they belong in our conversations just as much as your medication dose does.
Sometimes we need to adjust the medication. Sometimes we need a more practical food plan, help with sleep, or an activity goal that fits your life. Sometimes we need to step back and ask whether something we added is still helping.
That is the approach behind the four elements of a successful weight loss program: support, healthy eating, physical activity, and medical management.
Please bring those questions to your appointments. Tell me what feels better, what feels worse, and what you’ve quietly been putting up with. If you suspect a medication is causing a problem, let’s review it together before you change or stop it.
My own experience reminded me how easy it is to keep searching for the next treatment without revisiting the one already in place.
I want us to keep asking both questions.
Let’s work together toward your healthiest weight—with a plan that helps you feel better, sleep better, and live better along the way.
Frequently Asked Questions
Is a higher dose of weight loss medication always better?
No. The right dose depends on how well the treatment is working, how you feel, and the side effects you experience. Sometimes a dose increase is appropriate; sometimes your plan needs a different adjustment. Review these decisions with your prescriber.
Why does sleep belong in a weight loss treatment plan?
Sleep supports overall health and can affect appetite, energy, and your ability to follow a food and activity plan. If your sleep is poor, bring it up at your weight management visits so it can be considered alongside your other treatment needs.
Should I stop a medication if I think it is affecting my sleep?
Speak with your prescriber before changing or stopping it. Your clinician can review possible side effects, other causes of disrupted sleep, and whether a change in dose, timing, or treatment is appropriate.
